Case

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Rehabilitation of a Mandibular Distal Extension Situation in a 89-year-old Patient with an Implant-supported Fixed Dental Prosthesis

Daniel Buser

A 89-year-old female patient had been referred to the Department of Oral Surgery and Stomatology at the University of Bern for consideration of implant therapy. A long-standing three-unit fixed dental prosthesis (FDP) supported by teeth 45 and 47 showed a loss of retention due to deep secondary caries at tooth 45. The referring dentist removed this tooth prior to referral. At that time, the patient had already undergone implant therapy at our department twice, at the age of 85, at which time hopeless maxillary premolars and molars had to be removed bilaterally. Implant-supported FDPs in both quadrants were provided by the referring dentist following implant surgery at our department, since the patient could not adapt to a removable dental prosthesis in the maxilla.
Surgical SAC classification
Straightforward
Prosthodontic SAC classification
Straightforward
Source
Treatment Guide 9
Purchase price
10 Academy Coins
CPD/CME
0.15 hours
Publication date: Mar 6, 2017 Last review date: Feb 28, 2017 Next review date: Feb 28, 2020

General information

Case Type Short Space
Jaw Mandible
Area Posterior
# of Teeth 3
# of Implants 2
Type of Implants One-Piece|Reduced-Diameter
Attachment One-Piece|Reduced-Diameter
Bone Augmentation No
Augmentation Materials -
Guided Surgery No
Soft Tissue Grafting None
Abutment Type Customized
Prosthesis Type FDP

Esthetic Risk Assessment

Esthetic Risk Factors Low Medium High
Medical Status Healthy Compromised
Smoking Habit Non-smoker Light smoker (< 10 cigarettes per day) Heavy smoker (≥ 10 cigarettes per day)
Patient's Esthetic Expectations Low Medium High
Lip Line No exposure of papillae Exposure of papillae Full exposure of mucosa margin
Periodontal Phenotype Low-scalloped, thick Medium-scalloped, medium-thick High-scalloped, thin
Shape of Tooth Crowns Rectangular Triangular
Infection at Implant Site None Chronic Acute
Bone Level at Adjacent Teeth ≤ 5 mm to contact point 5.5 to 6.5 mm to contact point > 7 mm to contact point
Prosthodontic Status of Neighboring Teeth Virgin Restored
Width of Edentulous Span 1 tooth (≥ 7 mm) 1 tooth (< 7 mm) 2 teeth or more
Soft Tissue Anatomy Intact Defective
Bone Volume Horizontally and vertically sufficient Horizontally deficient Deficient vertically or deficient vertically AND horizontally
  • * General SAC assessment modifiers that are also part of the ERA. To avoid redundancy they are listed in this section even if no complete ERA has been made.

  • ** Not applicable to the ERA of immediate placement cases and replaced by "Socket Integrity" listed below under "Surgical SAC Classification". For all other placement types this value is a classification determinant and listed here even if no complete ERA has been made.

Surgical SAC classification

SAC Level Straightforward
Defining Characteristics Up to three missing teeth to be replaced with an implant-borne prosthesis or prostheses
Modality -
Placement Protocol Early or late implant placement
Tooth Site -
Socket Morphology -
Socket Integrity -
Bone Volume Horizontally and vertically sufficient
Anatomic Risk Low
Esthetic Risk Low
Complexity Low
Risk of Complications Low

Prosthodontic SAC classification

SAC Level Straightforward
Defining Characteristics Up to three missing teeth to be replaced with an implant-borne restoration or restorations
Loading Protocol Conventional or early
Retention Screw-retained, with 2 splinted implants Screw-retained, with 2 splinted implants
Maxillomandibular Relationship -
Mesio-Distal Space Anatomic space corresponding to the missing teeth +/- 1 mm
Inter-Arch Distance > 8 mm
Bruxism Absent
Esthetic Risk Low
Provisional Implant-Supported Prosthesis - -
Interim Prosthesis during Healing - -
Occlusion/Articulation Harmonious
Occlusal Scheme/Issues -

Surgical SAC Modifiers

Periodontal Status Healthy

Prosthodontic SAC Modifiers

Soft Tissue Contour and Volume -

General SAC Modifiers

Oral Hygiene and Compliance Sufficient
Access Adequate
Craniofacial/Skeletal Growth Completed

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